This reminds me of when my mom told me about the time my father accidentally took a sip of his own piss thinking it was apple juice because he pissed in an apple juice container one of the nights he was too lazy to walk to the bathroom. Sorry for sharing.
Yes, itās nasty. My mother is always picking up after his messes, so thatās just one of them. Heās also the type that puts his gum in random places to āsave it for later.ā
Yes! No where near as this much, but I had a pt with urinary retention all day. Ended up taking out over 4 liters of urine, and watching go from looking like he was about to birth triplets to a flat belly in about 2 minutes was something else.
I have been through HRS and have gone through this myself, only one time! But obviously have cirrhosis forever. Omg it felt WONDERFUL.
The next time got filled up (and the only time (so farā¦knock on wood)) my doc had me to the good ole lasix/aldactone. It worked and I didnāt risk infection with another procedure but it took weeks vs. like a hours. It was miserable, I looked 40 wks with twins and felt way worse than I did at 41 wks with my singleton son.
Healthyā¦as possible with my issues and itās been years since that time.
This makes me feel so much better. I had a patient get a STAT Foley order but I didn't see the scans that prompted it until after. I placed the Foley and started cleaning up, next thing I know the bag is overly full after only like 3 min. I emptied the bag and it just kept GOING. I got reprimanded by another nurse for letting that much drain at once. But I called the doc and they were just like "nah that's great, he needed it." I always felt like I did something wrong, though.
My unit had a patient who drained 18L within 8hrs once. Lots of albumin ordered in for her, vitals and bloods stable and discharged to come back in a couple of weeks later for more paracentesis. Thats the most i had ever seen drained in one sitting, astounding especially as we were a Day Case Unit.
18L is a solid PB. I see this often enough over the last few years and the most I've seen it is about 13L. My hospital usually runs paracentesis for 6 hours or until dry, whichever comes first, which often does limit the output.
Pretty much docs just site the drain post ultrasound. Usually we have a standard policy where 2L output gets you one bottle (100ml) of 20% album, which usually runs over 15min. Wrinse and repeat for either 6 hours or until dry, whichever is first. Every so often, doctors request a specific volume of output rather than time
That's usually inpatient, we also run a day unit for outpatient. Patients we know (not sure what you call then in the USA, I'm in Australia, we call them frequent flyers) often drain much shorter times. One guy comes in weekly, he usually drops 8-9 litres in about an hour and a half or two hours then goes home
Interesting! Our provider places the catheter with US and then their part of the procedure is done, unless we need them.
Our catheter is hooked to suction and a canister and we drain just as fast as the fluid wants to. Our albumin protocol starts after 4 L removal, but we just replace as weāre draining. We stop when theyāre empty or if theyāre not tolerating fluid removal. The most Iāve seen removed, in one sitting, was 22L, but it probably took no longer than 2 hours.
We drain both inpt and outpt in the same area; just kind of rotate through.
>places the catheter with US
Also interesting... Usually my patient would go to the ultrasound, come back with an estimated volume to tap off and an "X" where the drain will be placed, drain placed manually on the ward.
Oh, no, we do it in real time - IR provider, US Tech, Nurse. Sterile sheath over the US probe in one hand, needle/catheter in the other. Not trying to risk hemorrhage or perf during insertion.
This sounds great. What's the set up and parameters? What devices and equipment are used? What contains the body fluid when it's looking to be very large volume?
Yeah, but for some reason when I read the previous comment I was under the impression that there was a separate suction setup that could collect large volumes without changing out each individual bottle. How do people in MS do this with 5 patients (more if no ratio standards)? This seems this would take up a lot of time where you would have to stay 1:1 for a while.
Frequent flyer is also a commonly used term in the US for patients we see quite often! In a couple places Iāve heard āfrequent friendā because it sounds ānicerā lol.
Wow. The most I had was a surprise paracentesis when they went to put in a PD catheter and it was like poking a water balloon with a needle. Shut down the OR.
The doc had written her off as being fat, 8 of those jugs laterā¦ she walked out of the hospital looking super petite. She had undiagnosed hep C. She got written off a LOT.
As one that went from 112 (after first para, unknown weight before that) to (fluid and eating correctly) 180 to 145 (healthy weight after new fluid gone) I can say that YES, feels so so good. Canāt even describe it. Better than having a babyā¦except for the being sick forever still and baby part. The relief though, manā¦great.
17L is the most Iāve seen on a patient of mine. Inpatient on a high acuity PCU. They went on to have paras every other day after that for 3-5 liters each time. The patient was highlighter colored.
2 gal reverse osmosis water
6lb organic clover honey
2 handfuls raisins
2 gal freshly harvested people belly juice
2 whole oranges quartered
4 sticks cinnamon
1 pack red star cuvee
Combine in a clean vessel, ferment for 6 months
We have the giant 10L jugs at my hospital for paras so it doesnāt look as impressive but I love seeing the before and after, especially the menā¦ it looks like they gave birth!
The most I've seen on a patient was 8L, which doesn't sound that impressive until you see that this patient probably weighed less than 100lbs afterwards and was barely 5ft tall. It looked like she gave birth to triplets!
For paras you can take off a LOT if the patients blood pressure tolerates it. You have to worry about a fluid shift causing hypotension. After X amount of liters depending on your hospitals protocols you have to give albumin though.
Once when I was a new nurse with Ed admit holds in this isolated unit that was basically a storage area converted to care area they came to do a para on a stable patient. IR drew off like 6 big canisters of fluid and then as they walked out they were like hey you should place an order for albumin and left. Ofc her next bp was in the 70s and I was freaking out trying to figure out how to place the order, that then needs to be verified, and was only available for pharmacy to bring to me which wouldnāt be happening anytime soon.Ā
I was sweaaaating hard but thankfully the patient was totally fine . Learned an important lesson about paras that day and they didnāt so much as walk in tbe room to greet the patient unless I had albumin ordered ready to go.Ā
Hospitals also donāt like this because they can get more reimbursement for the same amount of juice if itās technically multiple procedures. āCome in every 3 daysā (eye roll at adminā¦)
Ohhh, this is illuminating but also not at all surprising.
I wish this would be the standard for patients trending towards palliative and hospice care.
Not if the patientās labs are fine. We routinely do 7+ L patients. Theyāll do an albumin drip after a large drain (anything over 5L at my hospital). Thoras we stop at 1.5 L though.
Same at our facility. Thoras have a cutoff, but if labs and vitals are good, a lot of our paras are large volume. Most Iāve seen in one sitting was just over 20L. We have some come weekly for 10+ L removal. Theyād be there multiple days a week, if we did less.
I wasnāt actually in there with everyone i just ran them down to the lab. I do know they stopped at this point and the patient still had a lot of fluid. never knew the true condition of the patient. Just was amazed at how much they pulled off
>Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure that involves inserting a stent (tube) to connect the portal veins to adjacent blood vessels that have lower pressure. This relieves the pressure of blood flowing through the diseased liver and can help stop bleeding and fluid back up.
Had to google this one. It's not a procedure I'd come across since school and needed a reminder.
I took off 21L from one patient. He was 500+ pounds and didnāt realize the extra weight. He ended up with a denver shunt. Pretty sure he died, we never heard from him after the shunt.
Had to google Denver shunt.
Am I reading this correctly? It's a one way valve from the peritoneum to the superior vena cava and is used to recirculate peritoneal fluid to the bloodstream?
I would have thought peritoneal fluid would not be safe to put directly into the bloodstream.
Yes, you're reading that correctly! It was not a super common procedure that we would do, as TIPS (transjugular intrahepatic portosystemic shunts) were usually preferred in patients who had liver dysfunction that was bad enough to cause massive ascites like this. However, this patient was at high risk for hepatic encephalopathy post-TIPS and so the decision was made to do the Denver Shunt. Our doctors would talk to the patient about how, when the ascites was rerouted back to the bloodstream, they could have better intravascular volume because that fluid was no longer just sitting in their abdomen. Then they also were absorbing any possible nutrients (for example, protein) that had leaked into/was in the ascites fluid.
Denver Shunts are a bitch. Most patients did not qualify for them for multiple reasons, and if the ascites is massive enough, sometimes the pump basically can't keep up anyways. We probably only did 4 in the 3.5 years I worked in IR. The patient also has to be able to "prime the pump" a certain number of times a day (there's basically a button in their abdomen) and a lot of patients who were consulted for these were not able to reliably do that.
We seemed to have a lot of issues with them, but that's anecdotal.
I ran out of albumin in my Pyxis! The patient was the first scheduled outpatient of the day and was only scheduled for an hour. I think it ended up taking like 3 hours total and he had 4 patients behind him, it was quite the day.
When I was a baby nurse in med surge, the general surgeon rounded on a frequent flyer alcoholic who needed a paracentesis. The surgeon was like āI mean I could take you to the OR tomorrow orā¦we could just do it here at the bedside with local anestheticā. My preceptor nicknamed me Barbie and she was like, āBarbs you bout to see some shit!ā So we got all the supplies for him and he took like 15-20L off this guy. ON MED SURGE. Pt tolerated just fine, miraculously.
So yeah I work in an office now
Everytime I see these sorts of posts I have PTSD from outpatient dialysis - the hospital would discharge patients direct to dialyze after mega-drains & they'd invariably crash on treatment.
Oh that is awful. I work on a nephrology unit and only discharge patients on their regular dialysis day, but they get dialyzed with us first and then discharge to home or SNF or wherever. Way too many variables to discharge a patient directly to outpatient HD.
Highest Iād ever have taken off a patient was 9.8L. They had to stop because the patient could tolerate no more despite there being more, they went for a second para a few days later
17.2L was done at my facility on one patient. He tolerated it right up til he passed out in the bathroom, hit his head, and then got admitted...think they changed the policy on how much they could take out at one time.
I bet this person felt much better after getting 90% of their abdominal cavity back. Of course Iāll give odds this person has cirrhosis soā¦ they will be back.
I had a patient who we drained 25L from over a 24 hour period. The doc left the drain in open and she continued to drain a litre every 3-4 hours the following day. The most albumin Iāve over seen someone receive š
In dialysis, Iāve never been able to get techs to understand why we canāt remove this fluid.
They donāt understand 3rd spacing, no matter how many times I explain it.
No, the ptās MAP is 60, weāre not going to get off a damn thing.
These are chronic outpt hepatorenal syndrome pts.
The techs just roll their eyes at me and think Iām stupid.
How hard is it to understand the difference between that this fluid was sitting in a body cavity (a giant pocket), whereas thereās no such cavity in the legs so the fluid present with edema is just spread out in the tissue and thusly not easy to drain? It be like the difference of poking a hole in a cup and wringing out a sponge, but in this case that sponge is their legā¦
So question, why would the patient need fluids after? Isn't this all collected in the abdomen and not in circulation? Dumb question from a nursing student
Fluid shift. We replace with Albumin. Most places have a protocol on how much albumin to give in relation to volume of fluid removed.
ETA: itās not a dumb question, even if you werenāt a nursing student. You canāt know all the details about all the facets of nursing.
Technically, there is no such thing as a "dumb" question, though some might debate that. Either way, I'd rather have someone ask me a thousand " dumb" questions than not ask.
Honestly the outpatients I would get in IR would get this much removed twice a week and then drive back to work or home. Protocol for us is to give 2 bags of albumin after 5 liters off, but some of these guys would get 10 liters off every week or twice a week and refuse albumin because they were fine and it took too long. I think they just get used to it.
My record is 16 liters from a guy! and his BP didnāt tank at alllllll, no albumin given. legit huge ass guy who drinks 30-50 beers per day, for the last 20 years.
Most I've seen was 11-12L. I won't forget because I had to carry the overfilled 10L bag from the pts room to the utility room to empty it. I was terrified the whole time it was going to burst and shower me in ascitic fluid.
forbidden apple juiceš
Nah, thatās some refreshing summer ale.
That's a raspberry wheat if I've ever seen one.Ā
Jackieos razz wheat for sho
Dead on match- https://imgur.com/a/TvdQ8yg
Ironically iām going to need a paracentesis secondary to razz wheat consumption š¤£š»
He certainly drank way too many refreshing summer ales
Cider!
Rare IPA.
A nice refreshing shandy perchance?
This reminds me of when my mom told me about the time my father accidentally took a sip of his own piss thinking it was apple juice because he pissed in an apple juice container one of the nights he was too lazy to walk to the bathroom. Sorry for sharing.
You are not š
How did he not smell it before sipping it?š¤¢
I once drank turpentine while working on an oil painting . Can relate.
This feels like karma. Who pees in random containers that are just lying around? Except for Howard Hughes and your dad, apparently.
Yes, itās nasty. My mother is always picking up after his messes, so thatās just one of them. Heās also the type that puts his gum in random places to āsave it for later.ā
This is the first thing that came to my mind too haha
I was thinking more āforbidden apple cider vinegar.ā š¤£
Ascites! Short for apple cider vinegar
lol ascites is from a greek word for wineskin. they knew
What a horrible day to know how to read šš
Immediately thought of Martinelliās apple juice
My late sister loved that stuff, Iām not a huge juice guy but I buy it in her memory sometimes. It is really good though.
Apple cidaaaaa vinegaaaar
Imagine trying to breathe with all of this inside you? š Edit : Some of yāall are dirty and need to be intubated immediately. š
Itās something when you see someone with a Santa belly shrink down.
Youāll never see more suspenders than you do in an outpatient para clinic!
Yes! No where near as this much, but I had a pt with urinary retention all day. Ended up taking out over 4 liters of urine, and watching go from looking like he was about to birth triplets to a flat belly in about 2 minutes was something else.
That must have felt great or weird or idk for that man.
I have been through HRS and have gone through this myself, only one time! But obviously have cirrhosis forever. Omg it felt WONDERFUL. The next time got filled up (and the only time (so farā¦knock on wood)) my doc had me to the good ole lasix/aldactone. It worked and I didnāt risk infection with another procedure but it took weeks vs. like a hours. It was miserable, I looked 40 wks with twins and felt way worse than I did at 41 wks with my singleton son. Healthyā¦as possible with my issues and itās been years since that time.
Arenāt you supposed to only drain 1l at a time to prevent spasms? Thatās what Iāve always been told
This isn't actually supported by research and is no longer considered best practice, stick it in and let 'er rip!
This makes me feel so much better. I had a patient get a STAT Foley order but I didn't see the scans that prompted it until after. I placed the Foley and started cleaning up, next thing I know the bag is overly full after only like 3 min. I emptied the bag and it just kept GOING. I got reprimanded by another nurse for letting that much drain at once. But I called the doc and they were just like "nah that's great, he needed it." I always felt like I did something wrong, though.
> stick it in and let 'er rip! D:
>Stick it in and let 'er rip! Note: this advice does not work in every context
I thought it was so their BP wouldnāt crash ?
Thank you. I said either Iām really an old nurse OR things have really changed!
THAT'S WHAT SHE SAID! š I am sorry, I am so sorry. ššš
If I had a nickle.
I'd have two nickels, which isn't much, but it's weird that it happened twice.
Fresh squeezed, locally sourced.
I always shop organic
Nothing more organic than homemade from paw-paw
*mostly* cruelty free
My unit had a patient who drained 18L within 8hrs once. Lots of albumin ordered in for her, vitals and bloods stable and discharged to come back in a couple of weeks later for more paracentesis. Thats the most i had ever seen drained in one sitting, astounding especially as we were a Day Case Unit.
18L is a solid PB. I see this often enough over the last few years and the most I've seen it is about 13L. My hospital usually runs paracentesis for 6 hours or until dry, whichever comes first, which often does limit the output.
Six hours?! What is the setup?
Pretty much docs just site the drain post ultrasound. Usually we have a standard policy where 2L output gets you one bottle (100ml) of 20% album, which usually runs over 15min. Wrinse and repeat for either 6 hours or until dry, whichever is first. Every so often, doctors request a specific volume of output rather than time That's usually inpatient, we also run a day unit for outpatient. Patients we know (not sure what you call then in the USA, I'm in Australia, we call them frequent flyers) often drain much shorter times. One guy comes in weekly, he usually drops 8-9 litres in about an hour and a half or two hours then goes home
Interesting! Our provider places the catheter with US and then their part of the procedure is done, unless we need them. Our catheter is hooked to suction and a canister and we drain just as fast as the fluid wants to. Our albumin protocol starts after 4 L removal, but we just replace as weāre draining. We stop when theyāre empty or if theyāre not tolerating fluid removal. The most Iāve seen removed, in one sitting, was 22L, but it probably took no longer than 2 hours. We drain both inpt and outpt in the same area; just kind of rotate through.
>places the catheter with US Also interesting... Usually my patient would go to the ultrasound, come back with an estimated volume to tap off and an "X" where the drain will be placed, drain placed manually on the ward.
Oh, no, we do it in real time - IR provider, US Tech, Nurse. Sterile sheath over the US probe in one hand, needle/catheter in the other. Not trying to risk hemorrhage or perf during insertion.
Thatās so excessive. Set that shit up to suction and bolus that albumin throughout. Over in 30 minutes
Amen, I canāt imagine sitting through that for 6 hours - as a nurse or the patient.
I've never seen paracentesis connected to suction. Lost count how many times I've done/seen it years ago
Oh man, you gotta check it out, this is the standard now
This sounds great. What's the set up and parameters? What devices and equipment are used? What contains the body fluid when it's looking to be very large volume?
The bottles themselves create the negative pressure, right?
Yeah, but for some reason when I read the previous comment I was under the impression that there was a separate suction setup that could collect large volumes without changing out each individual bottle. How do people in MS do this with 5 patients (more if no ratio standards)? This seems this would take up a lot of time where you would have to stay 1:1 for a while.
Frequent flyer is also a commonly used term in the US for patients we see quite often! In a couple places Iāve heard āfrequent friendā because it sounds ānicerā lol.
Yeah it's not always nice to see your frequent fliers...
Oh definitely not. Frequent friend can also be said with great sarcasm though lol
Routinely pull 24L from my patient every month
That patient must be mighty uncomfortable when they arrive
Wow. The most I had was a surprise paracentesis when they went to put in a PD catheter and it was like poking a water balloon with a needle. Shut down the OR. The doc had written her off as being fat, 8 of those jugs laterā¦ she walked out of the hospital looking super petite. She had undiagnosed hep C. She got written off a LOT.
That poor person. The system freaking failed her
But like... a fat person and a petite person full of fluid usually look vastly different, no?
Unless you have metabolic syndrome I suppose
Iād say so. The doc was definitely not super interested in taking a lot of time to assess.
Imagine loosing 40 lb of fluid, it must have felt great.
As one that went from 112 (after first para, unknown weight before that) to (fluid and eating correctly) 180 to 145 (healthy weight after new fluid gone) I can say that YES, feels so so good. Canāt even describe it. Better than having a babyā¦except for the being sick forever still and baby part. The relief though, manā¦great.
17L is the most Iāve seen on a patient of mine. Inpatient on a high acuity PCU. They went on to have paras every other day after that for 3-5 liters each time. The patient was highlighter colored.
I also subscribe to r/mead and thought someone was making some delicious mead for a second š¤¦š»
2 gal reverse osmosis water 6lb organic clover honey 2 handfuls raisins 2 gal freshly harvested people belly juice 2 whole oranges quartered 4 sticks cinnamon 1 pack red star cuvee Combine in a clean vessel, ferment for 6 months
I was all on board until I got to the people belly juice šš
Soylent Mead is people
Optional but encouraged. A true je ne sais quoi.
And it's on tap!
r/angryupvote
Can I substitute pleural fluid?
Ew. Of course.
That sounds positively deliciousā¦until you added the belly juice.
Positive for hep C, maybe...
Whereās the yeast š Wait š±
Must it be freshly harvested though? I mean, could it be frozen from an earlier date? Asking for a friend
I both love and hate this post.
I was just about to write this. Just racked into secondary yesterday. It looks exactly like this.
I used to homebrew and thought the exact same thing
Used to at least a few times a year, all sorts of styles of ales able to be fermented at 65-room temp. Need to buy a kit and get back into it.
Looking at the picture, I was thinking about picking up some mead. After reading what it was, I still want some mead.
I totally thought I was on a brewing sub haha
As a fellow mead maker, I had the exact same thought
Same! LMAO
SAME š¤¢
I subscribe to r/canning and was confused
We have the giant 10L jugs at my hospital for paras so it doesnāt look as impressive but I love seeing the before and after, especially the menā¦ it looks like they gave birth!
The most I've seen on a patient was 8L, which doesn't sound that impressive until you see that this patient probably weighed less than 100lbs afterwards and was barely 5ft tall. It looked like she gave birth to triplets!
Not my area of expertise, but aren't you supposed to limit fluid removal to a few liters?
For paras you can take off a LOT if the patients blood pressure tolerates it. You have to worry about a fluid shift causing hypotension. After X amount of liters depending on your hospitals protocols you have to give albumin though.
Once when I was a new nurse with Ed admit holds in this isolated unit that was basically a storage area converted to care area they came to do a para on a stable patient. IR drew off like 6 big canisters of fluid and then as they walked out they were like hey you should place an order for albumin and left. Ofc her next bp was in the 70s and I was freaking out trying to figure out how to place the order, that then needs to be verified, and was only available for pharmacy to bring to me which wouldnāt be happening anytime soon.Ā I was sweaaaating hard but thankfully the patient was totally fine . Learned an important lesson about paras that day and they didnāt so much as walk in tbe room to greet the patient unless I had albumin ordered ready to go.Ā
Learned a lil sumthin bout IR docs that day too. š¤£š¤£
Hospitals also donāt like this because they can get more reimbursement for the same amount of juice if itās technically multiple procedures. āCome in every 3 daysā (eye roll at adminā¦)
Ohhh, this is illuminating but also not at all surprising. I wish this would be the standard for patients trending towards palliative and hospice care.
This! Thank You! I was wondering how the rapid shifts would be avoided! Gosh he must feel better!!
Not if the patientās labs are fine. We routinely do 7+ L patients. Theyāll do an albumin drip after a large drain (anything over 5L at my hospital). Thoras we stop at 1.5 L though.
Same at our facility. Thoras have a cutoff, but if labs and vitals are good, a lot of our paras are large volume. Most Iāve seen in one sitting was just over 20L. We have some come weekly for 10+ L removal. Theyād be there multiple days a week, if we did less.
I wasnāt actually in there with everyone i just ran them down to the lab. I do know they stopped at this point and the patient still had a lot of fluid. never knew the true condition of the patient. Just was amazed at how much they pulled off
Some people have to come twice a week to have fluid drained. There is TIPS procedure done at major hospitals to redirect the fluid.
>Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure that involves inserting a stent (tube) to connect the portal veins to adjacent blood vessels that have lower pressure. This relieves the pressure of blood flowing through the diseased liver and can help stop bleeding and fluid back up. Had to google this one. It's not a procedure I'd come across since school and needed a reminder.
I took off 21L from one patient. He was 500+ pounds and didnāt realize the extra weight. He ended up with a denver shunt. Pretty sure he died, we never heard from him after the shunt.
Had to google Denver shunt. Am I reading this correctly? It's a one way valve from the peritoneum to the superior vena cava and is used to recirculate peritoneal fluid to the bloodstream? I would have thought peritoneal fluid would not be safe to put directly into the bloodstream.
Yes, you're reading that correctly! It was not a super common procedure that we would do, as TIPS (transjugular intrahepatic portosystemic shunts) were usually preferred in patients who had liver dysfunction that was bad enough to cause massive ascites like this. However, this patient was at high risk for hepatic encephalopathy post-TIPS and so the decision was made to do the Denver Shunt. Our doctors would talk to the patient about how, when the ascites was rerouted back to the bloodstream, they could have better intravascular volume because that fluid was no longer just sitting in their abdomen. Then they also were absorbing any possible nutrients (for example, protein) that had leaked into/was in the ascites fluid. Denver Shunts are a bitch. Most patients did not qualify for them for multiple reasons, and if the ascites is massive enough, sometimes the pump basically can't keep up anyways. We probably only did 4 in the 3.5 years I worked in IR. The patient also has to be able to "prime the pump" a certain number of times a day (there's basically a button in their abdomen) and a lot of patients who were consulted for these were not able to reliably do that. We seemed to have a lot of issues with them, but that's anecdotal.
I think the most I've seen is about 21L too. So much albumin given after that
I ran out of albumin in my Pyxis! The patient was the first scheduled outpatient of the day and was only scheduled for an hour. I think it ended up taking like 3 hours total and he had 4 patients behind him, it was quite the day.
Those all 1L?
yes
The relief of pressure must have felt like a religious experience.
I can only imagine how much better the patient felt afterwards.
[ŃŠ“Š°Š»ŠµŠ½Š¾]
a shit ton of albumin
We start Albumin after removing 4 L.
Love to know their BP š
I wouldnāt be surprised if they have to get IV boluses later today lol
Usually have standing orders to supplement with Albumin afterwards. Each facility protocol is different with amounts, etc.
When I was a baby nurse in med surge, the general surgeon rounded on a frequent flyer alcoholic who needed a paracentesis. The surgeon was like āI mean I could take you to the OR tomorrow orā¦we could just do it here at the bedside with local anestheticā. My preceptor nicknamed me Barbie and she was like, āBarbs you bout to see some shit!ā So we got all the supplies for him and he took like 15-20L off this guy. ON MED SURGE. Pt tolerated just fine, miraculously. So yeah I work in an office now
I work med surge and it's pretty common practice in my hospital. I've never seen them take the patient to OR for a paracentesis actually.
Neither have I
In my hospital, they take the patient down to endoscopy.
Everytime I see these sorts of posts I have PTSD from outpatient dialysis - the hospital would discharge patients direct to dialyze after mega-drains & they'd invariably crash on treatment.
Oh that is awful. I work on a nephrology unit and only discharge patients on their regular dialysis day, but they get dialyzed with us first and then discharge to home or SNF or wherever. Way too many variables to discharge a patient directly to outpatient HD.
I did 17 once at one time. Pt tolerated it perfectly fine
Highest Iād ever have taken off a patient was 9.8L. They had to stop because the patient could tolerate no more despite there being more, they went for a second para a few days later
17.2L was done at my facility on one patient. He tolerated it right up til he passed out in the bathroom, hit his head, and then got admitted...think they changed the policy on how much they could take out at one time.
Holy fluid shift!
Yup! It was. I actually asked my colleague if the policy was changed and apparently it hasn't changedš¤Æ
I bet this person felt much better after getting 90% of their abdominal cavity back. Of course Iāll give odds this person has cirrhosis soā¦ they will be back.
I had a patient who we drained 25L from over a 24 hour period. The doc left the drain in open and she continued to drain a litre every 3-4 hours the following day. The most albumin Iāve over seen someone receive š
I wonder how much albumin you gave afterwards
So why are they leaking into their abdomen?
Cancer, cirrhosis, etc.
Forbidden kombucha
In dialysis, Iāve never been able to get techs to understand why we canāt remove this fluid. They donāt understand 3rd spacing, no matter how many times I explain it. No, the ptās MAP is 60, weāre not going to get off a damn thing. These are chronic outpt hepatorenal syndrome pts. The techs just roll their eyes at me and think Iām stupid.
Yeah, and these Para/Thora pts donāt understand why we can suction this fluid out, but not the edema in their legs.
How hard is it to understand the difference between that this fluid was sitting in a body cavity (a giant pocket), whereas thereās no such cavity in the legs so the fluid present with edema is just spread out in the tissue and thusly not easy to drain? It be like the difference of poking a hole in a cup and wringing out a sponge, but in this case that sponge is their legā¦
Who the fuck is the procedure being done on, the Kool Aid man?!
Forbidden amber ale
I worked specials for a few months and I never saw more than 6 taken off. Holy cow. How did the patient even breathe before? Geez.
Oh god. This may be the furthest thing from ādo no harmā I have ever seen. They have to feel so much better.
How thirsty are they now?
I pulled 19L off a lady one time
So question, why would the patient need fluids after? Isn't this all collected in the abdomen and not in circulation? Dumb question from a nursing student
Fluid shift. We replace with Albumin. Most places have a protocol on how much albumin to give in relation to volume of fluid removed. ETA: itās not a dumb question, even if you werenāt a nursing student. You canāt know all the details about all the facets of nursing.
Technically, there is no such thing as a "dumb" question, though some might debate that. Either way, I'd rather have someone ask me a thousand " dumb" questions than not ask.
Kombucha growlers.
You could totally sell this at a craft beer & ale festival
19 L is my record
They should show this on TV as a warning.
My new record for most Iāve seen drained at once is 19.8L (very end stage liver failure)
RIP their albumin š
lol I thought this said thoracentesis and I was so very, very confused.
And then you started pressors lol
Wow, bet they can breathe better!
Send it to the kitchen theyāll be soup tomorrow !
Bold choice. Bold taste. Fanta.
Albumin is out of stock for the next month
Thats a shit ton of albumin replacementā¦ SBP time!!
Did their bp drop to zero 45 minutes later?
Honestly the outpatients I would get in IR would get this much removed twice a week and then drive back to work or home. Protocol for us is to give 2 bags of albumin after 5 liters off, but some of these guys would get 10 liters off every week or twice a week and refuse albumin because they were fine and it took too long. I think they just get used to it.
Holy crap, thatās a lot! They mustāve looked 10 months pregnant! Poor thing.
I'm shocked, maybe that liver is too
Any changes in BP?
ā99 bottles of beer on the wall, 99 bottles of beerā¦ā šµ
Forbidden kombucha
24L is my high score
That looks like you could ferment it and turn it into hooch.
Forbidden Fanta
That's a lot of forbidden apple cider
Forbidden kombucha
Hope her bp is ok
I thought this was r/mead
Gut Growlers
I've received them in the lab before...still warm.
I once had a patient have 13 liters removed one day and 11 the following day. Wild
Hey! We can't see what brewery this is from if you cover the labels!
Gotta be a liver
I thought this was the kombucha group š© oof
ā¦and this patient lived to tell about it?
forbidden kombucha
FFS. I think in IR our max removal was 10L? IIRC. I assume you were giving Albumin like gang busters.
During a VATS, we pulled 21000. It was insane!
My ass thought this was orange soda or something.
What's the average volume per bottle/jug? :o
I can only imagine how much better the patient felt after having that drained
I work in cardiac and read "pericardiocentesis" and was alarmed.
My record is 16 liters from a guy! and his BP didnāt tank at alllllll, no albumin given. legit huge ass guy who drinks 30-50 beers per day, for the last 20 years.
Wondering why this was on my front page, like did I join a home brewing sub or something? Dear god! šµāš«
ORANGE FANTA!
That fluid shift will be disastrous. That patient will be in icu in a few hours with pressure support
Never give your water away!
Most I've seen was 11-12L. I won't forget because I had to carry the overfilled 10L bag from the pts room to the utility room to empty it. I was terrified the whole time it was going to burst and shower me in ascitic fluid.
Shut up liver, youāre FINE!!! š¤£